PROJECT SUMMARY: Over 60% of cancers occur in older persons, and the number of patients with cancer is expected to grow. Geriatric assessment (GA), a validated patient-centered approach for assessing health status, can identify older patients with cancer who are at risk of adverse outcomes. The majority of oncologists have not adopted GA, largely because of lack of knowledge on how to utilize GA to guide communication and decision-making. Two multicenter cluster randomized studies in the University of Rochester (UR) NCI Community Oncology Research Program (NCORP) led by the Principal Investigator (PI) are evaluating if a GA intervention can improve communication about age-related issues (funded by a Patient Centered Outcomes Research Institute contract) and reduce toxicity from cancer treatment (funded by a NCI R01) through improved decision- making. Our preliminary data illustrates that: 1) age-related concerns and symptom burden are not addressed effectively in oncology clinical encounters; 2) community oncologists often provide chemotherapy to frail older adults with serious consequences; 3) a significant proportion of older patients with advanced cancer undergoing treatment and their caregivers believe the cancer will be cured; and 4) the majority of older patients would choose to forgo cancer treatment if they knew there would be serious functional and/or cognitive consequences. The current proposal builds on the PI's geriatric oncology program by developing new patient-oriented research and providing opportunities for mentees in this underrepresented area. The PI, a geriatric oncologist, and the research team including experts in communication, palliative care, caregiver and geriatric oncology research are well positioned to complete the aims of this proposal. The overarching aims are to: 1) develop insight into how to improve communication between older patients with cancer, their oncologists, and their caregivers about age-related concerns and symptoms, the risks and benefits of treatment, and prognosis through secondary analyses of data from the PI's multi-site studies and 2) develop and implement an intervention to integrate GA into oncology care to improve communication about the risks and benefits of chemotherapy for older patients. With support of this K24, the PI will complete specific career development activities that will enhance her skills in communication research and for mentoring and leadership. With regard to expected outcomes, this proposal will fill vital gaps in knowledge regarding the mechanisms of how GA can improve communication and outcomes. This research will have a positive impact by providing a pragmatic mechanism for incorporating GA into community oncology clinics to improve outcomes of older adults with cancer through more effective communication. This K24 will allow the PI to bridge the fields of geriatric oncology and communication research by bringing together an interdisciplinary team of experts and geriatric oncology mentees through novel analyses of existing data from funded clinical trials and the implementation of a new project.